HIV is a sexually transmitted infection. It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS.

There’s no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations. But HIV continues to decimate populations in Africa, Haiti and parts of Asia.

Symptoms

The symptoms of HIV and AIDS vary, depending on the phase of infection.

Primary infection (Acute HIV)

The majority of people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible signs and symptoms include:

Fever

Headache

Muscle aches and joint pain

Rash

Sore throat

Swollen lymph glands, mainly on the neck

Although the symptoms of primary HIV infection may be mild enough to go unnoticed, the amount of virus in the bloodstream (viral load) is particularly high at this time. As a result, HIV infection spreads more efficiently during primary infection than during the next stage of infection.

Clinical latent infection (Chronic HIV)

In some people, persistent swelling of lymph nodes occurs during clinical latent HIV. Otherwise, there are no specific signs and symptoms. HIV remains in the body, however, and in infected white blood cells.

Clinical latent infection generally lasts around 10 years if you’re not receiving antiretroviral therapy. This phase can last for decades in people taking antiretroviral medications. But some people progress to more severe disease much sooner.

Early symptomatic HIV infection

As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic signs and symptoms such as:

Fever

Fatigue

Swollen lymph nodes—often one of the first signs of HIV infection

Diarrhea

Weight loss

Oral yeast infection (thrush)

Shingles (herpes zoster)

Progression to AIDS

If you receive no treatment for your HIV infection, the disease typically progresses to AIDS in about 10 years. By the time AIDS develops, your immune system has been severely damaged, making you susceptible to opportunistic infections—diseases that wouldn’t usually trouble a person with a healthy immune system.

The signs and symptoms of some of these infections may include:

Soaking night sweats

Recurring fever

Chronic diarrhea

Persistent white spots or unusual lesions on your tongue or in your mouth

Persistent, unexplained fatigue

Weight loss

Skin rashes or bumps

When to see a doctor

If you think you may have been infected with HIV or are at risk of contracting the virus, see a health-care provider as soon as possible.

Treatment

There’s no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each class of anti-HIV drugs blocks the virus in different ways. It’s best to combine at least three drugs from two classes to avoid creating strains of HIV that are immune to single drugs.

Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine-tenofovir (Truvada), and lamivudine-zidovudine (Combivir).

Integrase inhibitors. These drugs work by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells. Examples include raltegravir (Isentress), elvitegravir (Vitekta) and dolutegravir (Tivicay).

When to start treatment

Everyone with HIV infection, regardless of CD4 count, should be offered antiviral medication.

HIV therapy is particularly important for the following situations:

You have severe symptoms.

You have an opportunistic infection.

Your CD4 count is under 350.

You’re pregnant.

You have HIV-related kidney disease.

You’re being treated for hepatitis B or C.

Treatment can be difficult

HIV treatment regimens may involve taking multiple pills at specific times every day for the rest of your life. Side effects can include:

Nausea, vomiting or diarrhea

Heart disease

Weakened bones or bone loss

Breakdown of muscle tissue (rhabdomyolysis)

Abnormal cholesterol levels

Higher blood sugar levels

Other diseases and treatment

Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related cardiovascular, metabolic and bone conditions, for example, may not interact well with anti-HIV medications. Talk to your doctor about other conditions for which you’re taking medication.

Treatment response

Your doctor will monitor your viral load and CD4 counts to determine your response to treatment. Viral load should be tested at the start of treatment and then every three to four months during therapy. CD4 counts should be checked every three to six months.

HIV treatment should reduce your viral load to the point that it’s undetectable. That doesn’t mean your HIV is gone. It just means that the test isn’t sensitive enough to detect it. You can still transmit HIV to others when your viral load is undetectable.